California Appeals Supervisor

Job Summary

A company is looking for a Supervisor Appeals and Grievances.

Key Responsibilities

• Supervise and develop a team of appeals and grievances coordinators to enhance performance and efficiency
• Manage member and provider appeals and grievances, ensuring compliance with policies and timely processing
• Monitor trends in appeals and grievances, preparing reports and recommending corrective actions as needed

Required Qualifications

• 3+ years of experience in healthcare appeals and grievances, with at least 2 years in a supervisory role
• Associates degree or 3 years of related job experience in lieu of a degree
• Familiarity with healthcare regulations, including HIPAA and CMS
• Previous experience at a health plan or managed care organization preferred
• Strong technical proficiency in data analysis and database software preferred